Healthcare Provider Details

I. General information

NPI: 1487493227
Provider Name (Legal Business Name): JESSICA JOYCE ROGERS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N WACKER DR STE 1150
CHICAGO IL
60606-1744
US

IV. Provider business mailing address

47 WHEATON PL
RUTHERFORD NJ
07070-2713
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-7598
  • Fax:
Mailing address:
  • Phone: 201-394-4847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-2501
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: